Oliceridine is a G protein–biased µ-opioid, a drug class that is associated with less respiratory depression than nonbiased opioids, such as morphine. The authors quantified the respiratory effects of oliceridine and morphine in elderly volunteers. The authors hypothesized that these opioids differ in their pharmacodynamic behavior, measured as effect on ventilation at an extrapolated end-tidal Pco2 at 55 mmHg, V̇E55.
This four-arm double-blind, randomized, crossover study examined the respiratory effects of intravenous 0.5 or 2 mg oliceridine and 2 or 8 mg morphine in 18 healthy male and female volunteers, aged 55 to 89 yr, on four separate occasions. Participants’ CYP2D6 genotypes were determined, hypercapnic ventilatory responses were obtained, and arterial blood samples were collected before and for 6 h after treatment. A population pharmacokinetic–pharmacodynamic analysis was performed on V̇E55, the primary endpoint; values reported are median ± standard error of the estimate.
Oliceridine at low dose was devoid of significant respiratory effects. High-dose oliceridine and both morphine doses caused a rapid onset of respiratory depression with peak effects occurring at 0.5 to 1 h after opioid dosing. After peak effect, compared with morphine, respiratory depression induced by oliceridine returned faster to baseline. The effect-site concentrations causing a 50% depression of V̇E55 were 29.9 ± 3.5 ng/ml (oliceridine) and 21.5 ± 4.6 ng/ml (morphine), the blood effect-site equilibration half-lives differed by a factor of 5: oliceridine 44.3 ± 6.1 min and morphine 214 ± 27 min. Three poor CYP2D6 oliceridine metabolizers exhibited a significant difference in oliceridine clearance by about 50%, causing higher oliceridine plasma concentrations after both low- and high-dose oliceridine, compared with the other participants.
Oliceridine and morphine differ in their respiratory pharmacodynamics with a more rapid onset and offset of respiratory depression for oliceridine and a smaller magnitude of respiratory depression over time.
- After μ-opioid receptor activation, oliceridine selectively engages the G protein–coupled signaling pathway, which is associated with analgesia, and has reduced engagement of the β-arrestin pathway, which is associated with adverse effects such as respiratory depression
- In healthy young males, oliceridine had a higher probability of providing analgesia than producing respiratory depression over the clinically relevant concentration range, while morphine had a higher probability of producing respiratory depression than providing analgesia
- Older and somewhat obese individuals of both sexes may be more vulnerable to opioid-induced respiratory depression than younger individuals
- The hypothesis that oliceridine and morphine differ in their pharmacodynamic behavior, measured as effect on ventilation at an extrapolated end-tidal Pco2 of 55 mmHg (V̇E55), was tested in a four-arm, double-blind, randomized crossover study of eighteen 56- to 87-yr-old male and female volunteers
- The effect-site oliceridine concentration causing a 50% depression of V̇E55 was 39% higher than that of morphine
- The onset and offset of the respiratory effect of oliceridine was five times faster than that of morphine